PGx Cost Savings Sources
| Savings Source | Mechanism | Estimated Savings per Member |
|---|---|---|
| Adverse drug event prevention | Avoid hospitalizations from drug toxicity | $5,000–$15,000 per prevented event |
| Failed medication cycle reduction | Reduce trial-and-error prescribing | $2,000–$8,000 per member |
| Optimal first-line therapy | Select the right drug the first time | $1,000–$3,000 per member |
| Reduced office visits | Fewer follow-up visits for medication adjustment | $500–$1,500 per member |
Mental Health PGx Value
Mental health medications are the highest-value PGx application. The average psychiatric patient tries 3–4 antidepressants or antipsychotics before finding one that works. PGx testing can identify which medications are likely to work based on the patient's CYP2D6 and CYP2C19 genetic profile — reducing the failed medication cycle from 12–18 months to 1–2 months.
ROI Timeline
IQ Insight
PGx savings are realized over 12–24 months as medication optimization takes effect. A member who receives PGx testing in January may not realize the full savings until the following year — when their optimized medication regimen reduces hospitalizations, ER visits, and office visits. Plan for a 12–24 month ROI timeline when evaluating PGx programs.